SAUNDERS Renal Medications EVOLVE

The nurse is reinforcing dietary instructions to a client who is currently prescribed probenecid (Benemid). Which food should the nurse encourage the client to continue to eat?

Spinach Rationale: Probenecid inhibits the reabsorption of uric acid by the kidneys and promotes excretion of uric acid in the urine. Clients taking this medication are instructed to limit excessive purine intake. High-purine foods to avoid or limit include organ meats, sardines, scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, and yeast. Spinach is not a high-purine food.

The nurse is caring for a client with kidney failure. The serum phosphate level is reported as 7 mg/dL. Which medication should the nurse plan to administer as prescribed to the client?

Aluminum hydroxide gel Rationale: The normal serum phosphate level is 3 to 4.5 mg/dL. The client in this question is experiencing hyperphosphatemia. Certain medications can be given to increase fecal excretion of phosphorus by binding phosphorus from the food in the gastrointestinal tract. Aluminum hydroxide gel is one such medication. Calcium gluconate and calcium chloride are medications used in the treatment of tetany that occurs from acute hypocalcemia. Calcitonin, a thyroid hormone, decreases the plasma calcium level by increasing the incorporation of calcium into the bones, thus keeping it out of the serum.

The nurse who is administering bethanechol chloride (Urecholine) is monitoring for acute toxicity associated with the medication. The nurse should check the client for which sign of toxicity?

Bradycardia Rationale: Toxicity (overdose) produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Treatment includes supportive measures and the administration of atropine sulfate subcutaneously or intravenously.

A client receiving nitrofurantoin (Macrodantin) calls the health care provider's office complaining of side effects related to the medication. Which side effect indicates the need to stop treatment with this medication?

Chest pain Rationale: Gastrointestinal (GI) effects are the most frequent adverse reactions to this medication and can be minimized by administering the medication with milk or meals. Pulmonary reactions, manifested as dyspnea, chest pain, chills, fever, cough, and the presence of alveolar infiltrates on the x-ray should indicate the need to stop the treatment. These symptoms resolve in 2 to 4 days following discontinuation of this medication.

The nurse is caring for a client diagnosed with Parkinson's disease who is prescribed benztropine mesylate (Cogentin) daily. The nurse reinforces instructions to both the client and the spouse regarding the side effects of this medication and the need to report which side effect if it occurs?

Inability to urinate Rationale: Urinary retention is a side effect of benztropine mesylate. The nurse should instruct the client or spouse about the need to monitor for difficulty with urinating, a distended abdomen, infrequent voiding in small amounts, and overflow incontinence.

Methenamine (Urex), a urinary antiseptic, is prescribed for the client. The nurse reviews the client's medical record and should contact the health care provider regarding which documented finding to verify the prescription? Refer to chart.

Renal insufficiency Rationale: Methenamine is a urinary antiseptic. Methenamine can cause crystalluria and should not be used in clients with renal impairment.Therefore, the nurse would verify the prescription if the client had a documented history of renal insufficiency. The laboratory and diagnostic test results are normal findings. Folic acid (vitamin B6) may be prescribed for a client with renal insufficiency to prevent anemia.

The nurse prepares to administer sodium polystyrene sulfonate (Kayexalate) to a client with chronic kidney disease for which laboratory abnormality?

Potassium level of 7.2 mEq/L Rationale: Sodium polystyrene sulfonate is a cation exchange resin used in the treatment of hyperkalemia. The resin either passes through the intestine or is retained in the colon. It releases sodium ions in exchange for primarily potassium ions. The therapeutic effect occurs 2 to 12 hours after oral administration and longer after rectal administration.

Bethanechol chloride (Urecholine) is prescribed for a client with urinary retention. Which disorder should be a contraindication to the administration of this medication?

Urinary strictures Rationale: Bethanechol chloride (Urecholine) can be harmful to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions.

A urinary analgesic is prescribed for a client with a urinary tract infection. When should the nurse tell the client that it is best to take the medication?

With Meals Rationale: A urinary antiseptic is administered with meals to decrease gastrointestinal side effects.

The nurse is reinforcing instructions to a client with glaucoma receiving acetazolamide (Diamox) daily. Which statement by the client indicates an understanding of the adverse effects related to the medication?

"I need to call the doctor if I notice dark urine and stools." Rationale: Acetazolamide is a carbonic anhydrase inhibitor. Nephrotoxicity and hepatotoxicity occur and are manifested by dark urine and stools, pain in the lower back, jaundice, dysuria, crystalluria, renal colic, and calculi. Bone marrow depression also may occur.

The nurse is preparing a subcutaneous dose of bethanechol chloride (Urecholine) prescribed for a client with urinary retention. Before giving the dose, the nurse checks to see that which medication is available on the emergency cart?

Atropine Sulfate Rationale: Administration of bethanechol chloride could result in cholinergic overdose. The antidote is atropine sulfate (an anticholinergic), which should be readily available for use if overdose occurs. Acetylcysteine is the antidote for acetaminophen overdose. Protamine sulfate is the antidote for heparin. Vitamin K is the antidote for warfarin (Coumadin).

The client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which medication?

Decongestants Rationale: Episodes of urinary retention can be triggered by certain medications such as decongestants, anticholinergics, and antidepressants. Diuretics, antibiotics, and antitussives generally do not trigger urinary retention. Retention also can be precipitated by other factors such as alcoholic beverages, infection, bed rest, and becoming chilled.

After kidney transplantation, cyclosporine (Sandimmune) is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication?

Elevated blood urea nitrogen level Rationale: Nephrotoxicity can occur from the use of cyclosporine (Sandimmune). Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels. Cyclosporine does not depress the bone marrow.

Propantheline bromide (Pro-Banthine) is prescribed for a client with bladder spasms. Which disorder, noted in the client's record, alerts the nurse to question the prescription for this medication?

Glaucoma Rationale: Propantheline bromide is contraindicated in clients with narrow-angle glaucoma, obstructive uropathy, gastrointestinal disease, or ulcerative colitis.

A client with chronic kidney disease is receiving epoetin alfa (Epogen, Procrit). Which laboratory result should indicate a therapeutic effect of the medication?

Hematocrit of 32% Rationale: Epoetin alfa is used to reverse anemia associated with chronic kidney disease. A therapeutic effect is seen when the hematocrit is between 30% and 33%. The laboratory tests noted in the other options are unrelated to the use of this medication.

The nurse caring for a client taking tamsulosin (Flomax) determines that which finding indicates the need for follow-up?

Pulse rate of 120 beats per minute Rationale: Tamsulosin (Flomax) is classified as benign prostatic hyperplasia agent and acts by relaxing smooth muscle and increasing urinary flow. An adverse effect of this medication is first-dose syncope, which usually occurs within the first 30 to 90 minutes of the initial dose. This is commonly preceded by tachycardia (pulse of 120 to 160 beats per minute). Side effects of this medication include dizziness, drowsiness, nasal congestion, and vertigo.

Oxybutynin chloride (Ditropan XL) is prescribed for a client with neurogenic bladder. Which sign would indicate a possible toxic effect related to this medication?

Restlessness Rationale: Toxicity (overdosage) of this medication produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a frequent side effect of the medication but does not indicate overdose.

Trimethoprim-sulfamethoxazole (TMP-SMZ) is prescribed for a client. The nurse should instruct the client to report which symptom if it developed during the course of this medication therapy?

Sore throat Rationale: Clients taking trimethoprim-sulfamethoxazole (TMP-SMZ) should be informed about early signs of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client should be instructed to notify the health care provider (HCP) if these symptoms occur. The other options do not require HCP notification.

Bethanechol chloride (Urecholine) is prescribed for a client. When should the nurse tell the client to take the medication?

Two hours after meals Rationale: Administration of bethanechol with meals can cause nausea and vomiting in the client. To avoid this problem, oral doses should be administered 1 hour before meals or 2 hours after meals.

Phenazopyridine hydrochloride (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. Which should the nurse reinforce to the client?

A reddish-orange discoloration of the urine may occur. Rationale: The nurse should instruct the client that a reddish-orange discoloration of urine may occur. The nurse also should instruct the client that this discoloration can stain fabric. The medication should be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication.

A client has been prescribed allopurinol (Zyloprim). The nurse reinforces which information concerning the administration of the medication?

Drink at least eight glasses of fluid every day. Rationale: Clients taking allopurinol are encouraged to drink 2000 to 3000 mL of fluid a day to prevent the formation of crystals in the urine. Allopurinol is to be given with or immediately following meals or milk. If the client develops a rash, irritation of the eyes, or swelling of the lips or mouth, the health care provider should be notified because this may indicate hypersensitivity.

The nurse is reinforcing discharge instructions to a client receiving sulfadiazine. Which should be included in the list of instructions?

Maintain a high fluid intake. Rationale: Each dose of sulfadiazine should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfadiazine cause urine to turn dark brown or red. This does not indicate the need to notify the HCP.

A client with a urinary tract infection with dysuria is given a prescription for phenazopyridine hydrochloride (Pyridium) for symptom relief. Which should the nurse reinforce instructing the client about this medication?

Expect the urine to become reddish orange. Rationale: Phenazopyridine hydrochloride is a urinary tract analgesic with no antimicrobial properties. It can cause a reddish orange discoloration of urine and tears and can stain undergarments and soft contact lenses. The medication should be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication and does not warrant notifying the health care provider.

The nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. Which should be included in the plan of care for instructions?

Maintain a high fluid intake. Rationale: Each dose of sulfisoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfisoxazole cause the urine to turn dark brown or red. This does not indicate the need to notify the health care provider.

Bethanechol (Urecholine) is prescribed for the client with urinary retention, and an injectable form of bethanechol is available for use as prescribed. The nurse informs the client of the health care provider's prescription, knowing that the medication will be administered by which route?

Subcutaneously Rationale: The injectable form of bethanechol is intended for subcutaneous administration only. Bethanechol must never be injected intramuscularly or by the intravenous route because the resulting high drug levels can cause severe toxicity, resulting in bloody diarrhea, bradycardia, profound hypotension, and cardiovascular collapse.

A sulfonamide is prescribed for a client with a urinary tract infection. On review of the client's record, the nurse notes that the client is taking warfarin sodium (Coumadin) daily. Which prescription should the nurse anticipate for this client?

A decrease in the warfarin sodium (Coumadin) dosage Rationale: Sulfonamides can potentiate the effects of warfarin sodium (Coumadin), phenytoin (Dilantin), and orally administered hypoglycemics such as tolbutamide (Orinase). When an oral anticoagulant is combined with a sulfonamide, a decrease in the anticoagulant dosage may be needed.

In reviewing the admission assessment data and health care provider's prescriptions for a client with peptic ulcer disease, the nurse notes that the client has a history of renal disease. Based on this data, the nurse determines that which antacid should be prescribed for this client?

Aluminum hydroxide (Amphojel) Rationale: Aluminum hydroxide lowers serum phosphate by binding with dietary phosphorus to form insoluble aluminum phosphate. The phosphate is then excreted in the feces. Aluminum hydroxide will not affect the renal system as much as other antacids. The medications identified in options 2, 3, and 4 are partially excreted by the kidneys; therefore, they may cause a problem in clients with renal disease.